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� . <br /> / <br /> Date�./J�.a/.e1 P�b���wo,k�N���,��. /-33 _ <br /> Appliealion For Biap.oeoi._�1/2b3II6 <br /> P�JBLIC 1dVORKS PEF�Mi�` PubTolalfeoFeQ S _ <br /> Less Apu��Fea Paitl S <br /> p ) <br /> �01'dnCC D�IC V G�O nC <br /> i�rint or Type Only — <br /> Great North:aest Coust. 2721 - 116th St SE Everett 96208 337-7153 <br /> O�n�ner L1.iil�ng Address Ciry Zi� Phone <br /> Owner _ _ <br /> Applicant Mailing Atldress City Zip Phonc <br /> Ne�a duplex <br /> Describe Proposed Work _ <br /> —����-�� � — - � <br /> ProjectAddress�ifknown) �3dHF7E'Howard Ave. �TY� � <br /> Altach four 1�31 copies of plans fo•proposed work- Diaw tc scale antl note the followiny as appliwt�lr,: � <br /> • Property Lines • Cenlerlinr cf street ♦A <br /> • Outline and dimensions of all existing and • Indiwte North �� <br /> proposzd st�uclures on Ih�lot 6 Show any proposed gradinn r.h�nges <br /> • Existing and pioposed utilities A Show measurements ` <br /> lYY�� <br /> DO NOT WHITE BE:LOW THIS LINE � <br /> PERMIT CONDITIONS <br /> t.All calls tor inspeclion shall be made 24 hrs.ir�advance-phone 259•8814. m*� <br /> 2.All work shall be perormed in accordance witn this permit and curreM Ciry of Evereu Desi9n and Construction a/ <br /> Standards and Spe .ilications. <br /> 3.Call Location Und.r;;r.,�nd Service 48 hrs.be'oic you c'��y.TOLL FREE NUMBER 1•SOO•424-5555. �g <br /> Pg <br /> �' <br /> � <br /> � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �,Q� The undersigned owner/applicanl hereh.•;aqrees to hold and savc hann� <br /> less Ihe Ci�y of Everetl from any and all claims for dainar�es, cosls. <br /> /' � expenses, or causes of aclion that may arise because of ins�allatien <br /> /� / a��— and maintenance of the improvement or other right�ohway use heretc <br /> ����/G""�c�:�Y �� _ applieA lor and furlher agr=es to remove same upon notice Irom the <br /> Approver+tor C�n;�ctio / Date Ci1y and to replace public p�operty damaged thereby. <br /> �//' / �,�' '—�—/3 ._� ,� ,3 — 2—%/ <br /> FINAL WSP[CTION Date y�� - �'���� � —— <br /> Approved as Constructed Signature ol Applicant Date <br /> WORK AUTHORIZED Y THIS PERMIT MUST BE STAr7TED 'NITHIN <br /> evereG PUBLICWORKSDEPARTMENT 1�J0 UAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLFTION. THIS PERMIT MAY BE <br /> Evarett.WA Q8201 CANCELLED BY THE CITY UPO�I ANY STOPPAGE OF WORK ON THIS <br /> Fhene:259-8810 FROJECT OV[R 90 DAYS DUf7ATION. <br /> .. ��Ri� <br />